The Features and Treatment Effects on Keratoepitheliopathy for Meibomitis-Related Keratoconjunctivitis

Abstract

Meibomitis-related keratoconjunctivitis (MRKC) is characterized by meibomitis with corneal epithelial abnormalities, and can be divided into two types: MRKC accompanied with phlyctenular keratitis, and MRKC accompanied with keratoepitheliopathy that is similar to superficial punctate keratopathy (SPK). The purpose of this retrospective study was to investigate the characteristic features of keratoepitheliopathy and treatment outcomes for MRKC. This study involved 27 eyes of 18 MRKC patients (3 males and 15 females). National Eye Institute (NEI) scores and visual acuity were compared at pre and post treatment. All subjects were treated with a small-dose administration of clarithromycin. Keratoepitheliopathy characteristic to MRKC, yet different in appearance from SPK, was noted in 24 of the 27 eyes. Fluorescein staining revealed granular epithelial lesions generally larger than SPK that coexisted with small dark spots. In 17 eyes, keratoepitheliopathy was located within the pupillary zone, and the visual acuity in 12 eyes was less than 1.0. Our findings showed significant improvement in the NEI score in MRKC (p < 0.0001) and in visual acuity (p = 0.0157) post treatment, and the characteristic features of keratoepitheliopathy in MRKC that are often associated with decreased visual acuity were elucidated. The treatment of clarithromycin was found to be effective for MRKC with keratoepitheliopathy.

Keywords: clarithromycin; keratoepitheliopathy; meibomitis-related keratoconjunctivitis (MRKC).

Figure 1

(a) Representative case of non-phlyctenular-type meibomitis-related keratoconjunctivitis (non-PL-MRKC) prior to treatment. The diagnosis of meibomitis is made by the hyperemia of the lid margin and palpebral conjunctiva, and by the obstructive meibomian gland function. Fluorescein staining shows granular and slightly larger epithelial lesions than superficial punctate keratopathy (SPK), and the abnormal staining coexisted with small dark spots. (b) Representative case of non-PL-MRKC post treatment. Oral clarithromycin at a dose of 200 mg/day and 0.5% erythromycin-based eye drops (4 times daily) were administered. After 3 months of treatment, improvement of hyperemia of the lid margin and tarsal conjunctiva was observed, suggesting improvement of the meibomitis.

Figure 1

(a) Representative case of non-phlyctenular-type meibomitis-related keratoconjunctivitis (non-PL-MRKC) prior to treatment. The diagnosis of meibomitis is made by the hyperemia of the lid margin and palpebral conjunctiva, and by the obstructive meibomian gland function. Fluorescein staining shows granular and slightly larger epithelial lesions than superficial punctate keratopathy (SPK), and the abnormal staining coexisted with small dark spots. (b) Representative case of non-PL-MRKC post treatment. Oral clarithromycin at a dose of 200 mg/day and 0.5% erythromycin-based eye drops (4 times daily) were administered. After 3 months of treatment, improvement of hyperemia of the lid margin and tarsal conjunctiva was observed, suggesting improvement of the meibomitis.

Figure 2

Non-PL-MRKC case with characteristic keratoepitheliopathy. (a) Granular and slightly larger epithelial lesions than SPK. (b) Abnormal staining coexisting with small dark spots.

Figure 3

A case of non-PL-MRKC with characteristic keratoepitheliopathy (i.e., granular and slightly larger epithelial lesions than SPK and abnormal staining coexisting with small dark spots) in the pupillary zone. After a 2-month oral administration of clarithromycin at a dose of 200 mg/day and topical administration of 0.5% erythromycin-based eye drops (4 times daily), improvement of hyperemia of the lid margin and tarsal conjunctiva was observed, thus suggesting improvement of the meibomitis. Corrected visual acuity had decreased to 0.5, yet improved to 1.0 after treatment.

Figure 4

Changes in corneal epithelial damage score between that at pre and post treatment. Compared to that at before treatment, corneal epithelial damage similar to SPK was significantly improved after treatment with oral clarithromycin (p < 0.0001) [study of 22 cases; pre-treatment: 5.1 ± 1.9 points; post-treatment: 1.5 ± 1.3 points; based on the National Eye Institute score (a 15-point scale)]. Asterisk indicates a significant difference (p < 0.05).

Figure 5

The distribution of pre-treatment corrected visual acuity in non-PL-MRKC eyes. The distribution comprised 0.1–0.5 in 5 eyes, 0.6–0.9 in 7 eyes, and 1.0 or higher in 12 eyes. In 12 of the 24 non-PL-MRKC eyes, the mean corrected visual acuity had decreased to less than 1.0 at prior to treatment.

Figure 6

Changes in corrected visual acuity between that at pre and post treatment. In the 17 eyes in which a comparison of corrected visual acuity was possible at pre and post treatment, significant improvement was observed post treatment (p = 0.0157).